2027 ICD-10-CM Diagnosis Code K68.12Psoas muscle abscess
ICD-10-CM Codes›K00–K95›K65-K6A›K68
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 78
- Not Chronic
K68.12 is a billable ICD-10-CM diagnosis code for psoas muscle abscess. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 371 through 373, 791, 793. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 226 closely related codes. Coders also document this condition as abscess iliopsoas non-tuberculous. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Muscle disorders and Peritonitis and intra-abdominal abscess.
For Medicare Advantage risk adjustment, K68.12 maps to CMS-HCC Category 78 (Intestinal Obstruction/Perforation) under the V28 model, adding a risk factor of about 0.326 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
K68.12 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Abscess iliopsoas non-tuberculous
- Abscess of hip
- Abscess of thigh
- Iliopsoas abscess
- Muscle abscess of thigh
- Retroperitoneal abscess
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K68.12: its own notes plus those printed at Chapter 11. A note printed at a category, block or chapter applies to every code under it.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name K68.12, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming K68.12: they are not reported together with it, unless the two conditions are unrelated.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Retroperitoneal Abscess
an abscess that is located in the abdominal cavity posterior to the peritoneum.
Patient EducationClinical
Abscess
An abscess is a pocket of pus. You can get an abscess almost anywhere in your body. When an area of your body becomes infected, your body's immune system tries to fight the infection. White blood cells go to the infected area, collect within the damaged tissue, and cause inflammation. During this process, pus forms.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert K68.12 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About K68.12Overview
What is the ICD-10 code for psoas muscle abscess?
The ICD-10-CM code for psoas muscle abscess is K68.12 (sometimes written as K6812). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K68.12 (Retroperitoneal abscess) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report psoas muscle abscess on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K68.12 group to?
When psoas muscle abscess is the principal diagnosis on an inpatient stay, it groups to MS-DRG 372, 793, 791, 371, 373, with relative weights from 0.6945 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is K68.12 a CC or MCC?
CMS lists K68.12 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 226 closely related codes in its exclusion list.
What is the ICD-9 equivalent of K68.12?
Under the General Equivalence Mappings, psoas muscle abscess converts to ICD-9-CM 567.31 (psoas muscle abscess). The mapping is a direct match.
What HCC is K68.12?
K68.12 (psoas muscle abscess) maps to CMS-HCC Category 78 (Intestinal Obstruction/Perforation), commonly written as HCC 78, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 33 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does K68.12 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K68.12 adds a risk adjustment factor of about 0.326 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.326 to 0.688 depending on the payment segment). A more severe related category (HCC 77) supersedes it when both are reported. See the full factor table on the HCC 78 category page.
